RD Q&A (vol. 35)

Katelynn: My question for you is in regards to coconut oil. I did see that you had answered a question or two relating to this topic, but I was hoping for a little more explanation. I have recently seen coconut oil popping up in the lives of many friends, and I’m unsure as to the health benefits of it. I did some quick research the other day, and the articles and information I found didn’t seem to promote the use of coconut oil (granted, the research is limited and more should be done).  The people I know are using coconut oil while trying to lose weight, and have replaced it with every other oil they use (no more canola, olive, nadda). I guess my question is, is it healthy to use only coconut oil? And is it as healthy as everyone on my Facebook boasts that it is?

Prevention RD: There isn’t a lot of research, as you mentioned. What we know is that coconut oil is a medium chain triglyceride meaning it is absorbed directly into the blood stream and does not post the risks of atherosclerosis and high LDL levels like other saturated fats. HOWEVER, it’s still a fat! It is still packed with calories. It also has a very unique taste that personally, I just can’t use in everything (not that I would anyways). I love canola oil for its omega 3 content and olive oil for its low omega 6 fatty acid content and flavor. I use coconut oil in desserts where I want that particular flavor. There are a lot of oils that all have their pros and cons and marrying just one oil isn’t what I would recommend for a balanced diet. Does that help a bit? 🙂

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Callia: I was reading some of your (very helpful) posts about the relative merits of different oils, with a view to improving the omega-6:omega-3 ratio in my diet. From what you’ve written, I was all set to try flaxseed oil for salads, and canola oil for cooking.  But I can’t find canola oil on the shelves here in the UK.  I understand from this article that “commodity rapeseed oil” (which I can find) is much the same thing. But I must admit the article rather put me off from a flavour perspective! So I started hunting around and found this neat little table.  I grabbed the data and sorted it – first by sat-fat content, then by omega-6:omega-3 ratio, and finally by smoke point.  Assuming that the data are correct, and that my criteria make sense, it looks to me like the best oil for frying would be Macadamia nut oil, with Canola and Mustard (not that I’ve ever seen *that* on the shelves) a close second, and Walnut and Avocado not a bad third (I did read somewhere that Walnut oil can go a bit bitter at high temperatures though). I’ve not factored in cost yet, so I’ve no idea if that would be practical in the real world – but I just wondered whether the data in the table looks reputable to you, and whether you’d agree about which oils look “best”. Also, I wondered if there are other factors to consider when choosing a cooking oil for healthy eating, besides sat-fat, omega-6:omega-3, smoke point, flavour and cost? Thanks for taking the time to read this question! Love the blog – made quinoa cakes for the first time this week, absolutely delicious 🙂

Prevention RD: Love your name! 🙂 Great question. I would definitely go with the rapeseed oil (“aka” canola oil in the states). Try and find an organic version or one that is without GMO’s, but I recommend canola oil all the time, particularly because of its low cost, high smoke point, and high level of omega 3 fatty acids! I do hope that helps. I have no personal experience with macadamia nut, walnut, or avocado oils, unfortunately.

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Lizzie: Hey Nicole, what are your thoughts on/responses to this article?

Prevention RD: There probably isn’t enough bandwidth to accommodate all the words I’d love to say, but frankly, I disagree with quite a lot of what the article says. It’s written very well in that it is very vague — something that those outside the nutrition profession are great at. I mean, what is a “high protein” diet anyways? The article sure doesn’t specify, and yet I have seen in real life, excessive protein intakes (3+ grams per kilogram of body weight) over years cause long-term kidney damage. My biggest hot point was probably point #2, the comment about saturated fat not being linked to heart disease. There is a plethora of decades worth of research stating otherwise. In fact, saturated fat is the leading cause of elevated LDL-cholesterol levels. It’s not fat that’s the issue – it’s the types of fat (i.e. saturated and trans). I do agree with the point made about omega 6 fatty acids, for what it’s worth. I think the best part of the blog post was the comments. My personal favorite:

Kris,

It is true that I haven’t said anything to refute what you wrote and I do not intend to. Those who want to make true life changes will seek the expertise of a dietitian and not a blog (yours or anyone else’s). We are the only profession that will devote an hour to a client and listen to them talk- doctors, nurses and physician assistants will not. I’m not trying to belittle your blog or the articles you write, but people need more than bullet points to make true changes.

I saw a client today who has a history of bulimia and she previously sought nutritional counseling from her trainer at the gym. I’m not putting down trainers, I know you are one, but he forbade her from eating ketchup among other things. KETCHUP! YOU NEVER RESTRICT WITH A PATIENT THAT HAS STRUGGLED WITH AN EATING DISORDER- you will set them up for failure. It’s human nature. If someone tells me not to touch something, I’m going to touch it. This trainer made her FEAR food to the point where she no longer trusted her own judgement and with the exception of lunch (which consisted of grilled chicken and lettuce), ate nothing. That single comment had caused her a lot of angst. Luckily she reached out for help, but I now have to work on getting her to trust her internal hunger cues, but most importantly, food. Nobody should fear any food. Perhaps this is why I have such a distrust of non-dietitians dispensing nutritional counseling. I’ve seen it cause more harm then good countless times.

I tell you this story because as a med student who will one day become a doctor, you will not be able to help her. You won’t have the time. Bullet points will not work. I agree with Fran, you’ll see what we’re talking about one day. It’s not going to click now, but one day it will and hopefully you’ll remember us.

My personal motto: All foods fit….unless you have an allergy or a sensitivity to it, then it does not fit.

I wish you many successes in your future, but remember, nutrition is individualized and foods should not be demonized.

I think the “regular” readers of my blog fully recognize that I do not demonize foods and I eat everything…in moderation, with a large emphasis placed on a plant-based diet, abundant in fruits, vegetables, and whole grains. I’ve learned that everyone has an opinion on nutrition and I disagree with a lot of people. I’ve also learned that that’s okay. The work that most RD’s perform on a day-to-day basis is not working with well-educated individuals with deep pockets for groceries, but rather, helping individuals make small, impactful changes to influence the long-term complications of chronic disease.

I see a patient on a regular basis who can converse with me fact-by-fact about nutrition from iron to selenium to omega 3 fatty acids. The patients takes a handful of vitamins every morning, reads nutrition research, attends conferences put on by leading nutrition professionals…and he eats unhealthy choices at fast food restaurants 2-3 times per day. I don’t understand it, but knowledge is part of the picture…the rest is hard work, dedication, and willpower. It’s not easy, it’s not always simple. But when it comes to nutrition, I am main stream and am reluctant to ever side with any extreme whether it be veganism or organics or saturated fats.

That was a really long answer, Lizzie — see what you do to me! 🙂

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 Do YOU have a question you’d love answered? Please post as a comment or email me at preventionrd (at) gmail (dot) com.

Be well,

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19 Comments

  1. March 6, 2013 / 8:38 am

    I love reading these…have I told you that? Yes, I have.
    Ok, so I love your answer on the saturated fat debate. However, do you agree (and you don’t have to respond) that perhaps the main issue is not just that we are getting too much saturated fat, but that we aren’t getting ENOUGH unsaturated fat ( I know you mentioned this, but I think it’s important)? I think Americans eat saturated fat to the point where we aren’t getting enough of the omegas, therefore it’s double-bad. There was a VERY LONG article in the New York Times not too long ago about this…..and it goes back to that book I read by Gary Taubes called “Good Calories, Bad Calories”, it really made me think about fat in an entirely new light.
    As for the protein, UGH, more than 2g/kg and it defeats the entire purpose, you might actually LOSE muscle (some studies show). That’s insane.

    • Nicole, RD
      Author
      March 6, 2013 / 10:43 am

      Hey girl! For sure — everything I’ve seen in most recent years shows that percentage-wise, our fat intake is appropriate, but the types are not. I think there is an excess of calories overall and the obesity epidemic would support that. Especially omega 3’s and monounsaturated fat in the diet — there’s just not enough!

  2. Katie
    March 6, 2013 / 8:46 am

    I had to stop reading the comments in that linked article. I have busted ass for the past 5 years to complete my Dietetics degree and will hopefully be starting my 10 month long internship in September. For people to completely write-off sound advice from an RD is infuriating. Would you go to a “doctor” who hadn’t been to medical school? Probably not. So why would you see a “nutritionist” who’s never studied the subject? -end rant-

    Thanks for posting a reply to that article-we need to spread the word about how awesome RD’s are!

    • Nicole, RD
      Author
      March 6, 2013 / 10:45 am

      Katie, thank you! You said it perfectly. It’s pretty offensive to read some of those comments. But, because everyone eats…everyone believes themselves to be a nutrition expert. Sad, but true! So glad a strong, passionate, like-minded professional soon be an RD!! 🙂 Thanks for your comment – made my day!

  3. March 6, 2013 / 11:45 am

    Hi! I love that last question and answer. I have a question in regards to dealing with friends and family who think they know everything because a website says “blah blah” and say certain options are healthier than the way I made it. I’m also a senior in a DPD program and was just wondering, what is a good way to go about dealing with their “opinion”? When you know the science do you bother explaining it to them or just shrug it off? Or does it just depend on the person…

    • Nicole, RD
      Author
      March 6, 2013 / 12:04 pm

      Hi Kelly! Great question and promise me when I say this will continue until forever. I think it does depend on the person how you respond to these situations. I just “taught” my father-in-law last weekend about how to look for trans fats in the ingredient list and to not rely on labels when he was explaining how healthy Parkay is. But I’ve had patients where if I didn’t go along with their beliefs to a certain extent, I would’ve lost rapport with that individual. It’s truly shocking how invested and passionate others get about their nutrition beliefs, even if they are untrue. I think it gets easier to deal with these situations the more you encounter them, but I think it’s important to be factual and firm, but agreeable with points that may have some truth. For example, if someone tells me “low-carb diets are totally safe…everyone should be on a low-carb diet so they don’t gain weight.” I would explain that, “…while some people may find a carbohydrate CONTROLLED diet to be a great way to lose weight, everyone is different and that healthy, maintainable weight loss is achieved through moderate energy restriction. Carbohydrates are a source of energy and while it’s true that many processed foods are carbohydrate, so are fruits and vegetables.” If you put the right spin on it to get people thinking about the big picture, it usually works well. GREAT question!

  4. March 6, 2013 / 12:43 pm

    You can see how people don’t trust RDs anymore, now that they’ve been peddling a diet proven to be useless for several decades (see the Women’s Health Initiative).

    And no, please don’t give me the “balanced diet” line – this diet is barely any different from the low-fat diet proven to be useless. You just found a new name for it.

    You display a remarkable lack of understanding about biochemistry if you still think “a calorie is a calorie” and that sugar can be eaten in moderation like any other food. Many doctors (and also other, more enlightened RDs) understand it, why can’t you?

    In my opinion, and thousands of other peoples, the dietetics profession is a joke. A very harmful, bad joke.

    I mean you people are still telling DIABETICS to eat a HIGH-CARB diet? How could anyone possibly respect your opinion, knowing what kind of recommendations typically comes from RDs?

    • Nicole, RD
      Author
      March 6, 2013 / 1:22 pm

      Not worth a response. You clearly know it all, so I won’t bother.

      • March 6, 2013 / 1:42 pm

        I certainly don’t know it all, but I seem to know a lot more than you on many important issues. I’ve been studying nutrition on my own for years, even though I don’t have a degree in it.

        I suggest you freshen up your knowledge and dig into the literature and do some reading on biochemistry. Keywords to start with: insulin, leptin, leptin resistance, de novo lipogenesis, gluconeogenesis, ldl particle size.

        I have nothing against RDs per se and personally I am fascinated with the subject of nutrition. But I have big issues with how most (not all) RDs practice nutrition.

        When you reply to such comments, like my article with over 60 peer-reviewed references, you usually just say that “you know better because you’re an RD” and that what everyone else says is irrelevant.

        Most of mainstream nutrition, including the “a calorie is a calorie” mantra and the low-fat, high-carb paradigm, is based on pseudo-science and cherry picking.

        Regarding your comment on Saturated fat: Saturated fat raises Large LDL, not small, dense LDL. Small, dense LDL causes heart disease, Large LDL does not. Multiple massive studies (such as a massive 2010 meta-analysis) show that there is NO association between saturated fat and heart disease. You would know this if you had been keeping up with the research.

        You don’t need a college education to figure out how to eat healthy.

        • Nicole, RD
          Author
          March 6, 2013 / 2:44 pm

          So are you saying that all saturated fats are the same? Are you arguing that saturated fat is healthier than monounsatured fats and omega 3 fatty acids? If so, we should probably all be eating T-bones slathered in butter, right? Are those healthy calories? Because lord knows I don’t want to gain weight.

          I guess most importantly, since you have such a good understanding of nutrition for the population as a whole, why do you falsely assume that nutrition should be the same for all? Because um, that’s what RD’s do — teach people how to eat right for THEM, taking into account anthropometrics, labs, meds, family history, lifestyle, and so on. Do you consider any clinical data when giving people nutrition advice, or is an LDL of 160 advisable?

          Quite frankly, you can meta analysis this: I do this…every day. All day. In a clinical setting. I help people and that’s good enough for me.

          • March 6, 2013 / 3:02 pm

            Foods that naturally contain saturated fats are healthy. Yes, steak and butter are both healthy. Saturated fats and monounsaturated fats are fairly similar in their effects, most people eat way too much Omega-6 and too little Omega-3.

            I don’t assume that nutrition should be the same for all. I acknowledge the fact that we’re all different and what works for one person may not work for the next. Low-carb, real-food based diets are appropriate for those who are overweight or suffering from other metabolic issues like diabetes… which is more than half of Americans.

            I don’t give people any counseling besides answering a few simple questions via e-mails and comments. My articles are based on peer-reviewed studies from reputable journals like NEJM and AJCN, and what these studies reveal is usually the exact opposite of what is being peddled by most dietitians.

            “Personalized” nutrition is nonsense, you don’t need to see an RD to figure out how to eat “right for you” – Eating healthy is simple. I highly doubt your personalized recommendations vary much from the failed low-fat diet.

        • March 6, 2013 / 5:27 pm

          Kris- I cannot believe how being a med student, personal trainer and studying “nutrition” on your own- you do not value personalized nutrition & not respect fellow health care professionals. Being in a health care setting, I respect and understand that each profession specializes in their area of expertise aka dietitians for food and nutrition, personal trainers for exercise/fitness. Its so weird the way you think – eating healthy is simple and anyone can do it- but in reality people don’t thats why there are dietitians! I could say the same thing about personal trainers- i mean how hard is it to run on a tread mill, lift weight, go for a walk etc but its know that its not that easy and everyone has different fitness needs and special guidance is very beneficial to them that is why I always refer my clients to personal trainer in case of fitness question and dont tell them to start lifting x lbs, do x number of crunches etc because I do not have any experience nor education and I think its best for their success too. I strongly believe that everyone should try and stick to their area of expertise, refer to other health care professionals because it is best for the client/patients because that way they can get consistent evidence-based answers- which by the way dietitians do follow. You might be better at understanding biochemistry and all that scientific lingo better but when it comes to providing lifestyle changes nutrition counseling, nutrition therapy-dietitians are the expert because we are trained to translate those biochemistry terms, research into simple language that our client/patients can understand and be able to apply it in their real life, buy/cook things that is beneficial to them.

          • March 6, 2013 / 6:19 pm

            If you look at my site you will see that I use language understandable by most people. It’s not a bunch of scientific lingo. They are clear statements, supported by real references.

            “You might be better at better at understanding biochemistry and all that scientific lingo better …”

            Understanding biochemistry is critical if you want to understand how different diets and macronutrients affect the body… for example, why low-carb diets are probably best for diabetics, something that almost every dietitian I’ve spoken to does not have a clue about.

            The thing is, mainstream nutrition is stuck in a paradigm. The whole belief system was based on faulty evidence to begin with. The “calorie is a calorie” and “fat is bad” ideas are still affecting public policy even though they’ve been proven to be false.

  5. Lizzie
    March 6, 2013 / 3:02 pm

    My bad!

    • Nicole, RD
      Author
      March 6, 2013 / 3:09 pm

      Haha! I’m so very tempted to delete his posts, HOWEVER, I think it’s important for people to see all the whack advice that people are happy to share with anyone will to read and agree. 🙂

  6. Katie
    March 7, 2013 / 8:03 am

    I have read all the comments and tried to figure out why people hate RD’s so much. I have come to this conclusion: nobody understands what RD’s actually do. There really is no other explanation for such hatred. I don’t know any RD’s who would simply say “a calorie is a calorie” and that eating 2,000 calories worth of steak and butter is the same as 2,000 calories worth or fruits/veggies, whole grains, and lean meats/dairy. I also don’t know any RD’s who go around telling everyone they counsel that a “low-fat diet” is the best one. In fact, as science and knowledge has evolved, it has become clear that fat is vital and there is a shift towards encouraging healthy fats.

    I guess people also don’t realize that RD’s write tube-feeding orders, counsel patients with diabetes, adjust for protein, sodium, and potassium in the renal diet (highly variable depending on which stage of renal failure), evaluate dysphagia diets, ensure there are no nutrition interactions with each and every medication an individual is on, and adjust diet orders for all sorts of lab values. But I guess you’re right, we just tell everyone to eat a “balanced diet” and move on with our day.

    • Nicole, RD
      Author
      March 7, 2013 / 7:30 pm

      Hi Katie, thanks so much for your thoughtful reply. It’s disheartening to know that people really do not grasp the scope of an RD’s knowledge and capabilities. Despite such comments from “internet experts”, we know the truth…as do many others. 🙂

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